Republic of the Philippines

Department of Transportation
LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
Caraga Administrative Region XIII
Capitol Avenue, Butuan City

____________________________ Case No. ____________________________

Petitioner

In Re: PETITION FOR THE ISSUANCE OF

A SPECIAL PERMIT TO TRAVEL
OUTSIDE OF AUTHORIZED LINE
x --------------------------------------------------- x

PETITION
Petitioner unto this Honorable Board most respectfully avers:

1. That the petitioner is of legal age, Filipino, married/single and a resident of

____________________________________________________________ .
2. That the petitioner is the registered holder of Certificate of Public Convenience/
Decision granted in the above-entitled case number, with use of word (number)
unit/s hereunder described as follows:

MAKE:
MOTOR NUMBER:
CHASSIS NUMBER:
PLATE NUMBER:

3. That the petitioner desires to have a Special Permit to use his/her motor vehicle to
travel from _______________________ to ________________________ and
vice versa, dated MM DD YYYY until MM DD YYYY for the purpose of
__________________ .
4. That the petitioner is willing to comply wit whatever limitations that the Board
may impose upon such travel outside his/her authorized line.

WHEREFORE, it is most respectfully prayed that this Petition be favorably acted upon
and a Special Permit be granted.

Butuan City, Philippines; Date

________________________
Petitioner

SUBSCRIBED AND SWORN TO before me this DD day of Month, Year, at Butuan

City, Philippines.

Doc. No. ________

Page No. ________
Book No. ________
Series of 2018